Allergic Rhinitis Ebook

Hay Fever and Allergies

This eBook addressed the real causes of seasonal allergies like hay fever and other irritating health problems, and provides more informed solutions based on recent research into how to stop allergies at the system level. It doesn't take much now to be able to get rid of allergies, without having to see a doctor, pay huge medical and pharmaceutical bills, or fill your body with chemicals that do more harm than good to your system. However, if you are a doctor or run a clinic of any kind, you can learn things that you can apply to your own clinic to provide maximum benefit to you and your patients. Keep yourself informed with real research! When you find the underlying causes of allergic rhinitis (the medical term for hay fever) you will be far more informed on how to fight this in your own body. Take the natural way to heal yourself!

Hay Fever and Allergies Summary


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Author: Case Adams
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Optimize the Immediate Preoperative Condition

Check that the patient has had maximum preoperative medical treatment. It is surprising how often this is overlooked. Reducing the amount of inflammation at the time of surgery will make the operative field easier work in and will enable the surgeon do a safer and better job. The patient with infective rhinosinusitis should have had at least a minimum of 2 weeks of a broad-spectrum antibiotic with anaerobic cover for example, coamoxiclav or cefuroxime and metronida-zole (Fig. 8.4). For allergic rhinitis, the current ARIA guidelines summarize the best medical treatment (see Chapter 3, Table 3.1). It is particularly important to check compliance with topical nasal steroids. In severe nasal polyposis, and in particular when polyps lie medial to the middle turbinate and there is a reduction or absence of sense of smell, a course of oral steroids in the week before surgery should help reduce surgical damage to the olfactory mucosa. Oral steroids should be given as long as there are no...

How To Communicate the Benefits and Risks of Surgery to the Patient

It is very helpful to have the patient's CT scans with you to illustrate what is happening in their sinuses and what procedure is planned, and to show the proximity of the orbit and brain when discussing possible complications (Fig. 9.1). An alternative is to have a diagram of the sinuses available. We normally describe sinus surgery to patients who have little medical knowledge as plumbing of the sinuses. Another analogy that patients understand is describing the sinuses as 14 little rooms connected by corridors on either side, and sinus surgery as like these being converted into a big hall on each side (Fig.9.2a, b). We say that surgery helps drainage, reduces the surface area from which polyps can form, and allows access to topical nasal medication. However, it is important to emphasize that surgery is not always a cure for all of the patient's symptoms, particularly in the presence of allergic rhinitis or when the patient also has late-onset asthma.

Specific Forms Of Human Allergy

Hay Fever Descriptions of what is almost certainly hay fever (allergic rhinitis) date almost as far back as the beginning of written history. But despite its name, hay fever is not a fever, and only rarely is it caused by hay It is most often caused by pollens or other plant-associated products carried by wind allergies truly can be due to something in the air. In North America, one of the most serious offenders is ragweed, a plant that spreads its pollen throughout much of the summer and early autumn. But allergic rhinitis can be caused by any airborne allergen chemicals, dust, microbial spores, animal dander, fibers, or insect parts in addition to pollen. As the term allergic rhinitis implies, the nose is a particularly sensitive target. The nose is unusually rich in small blood vessels and secretory glands, related to its role in warming and moistening incoming air. Even in the absence of an allergic reaction, the nose may secrete as much as a quart of water Hay fever-like symptoms...


A decongestant is a drug that reduces swelling of the nasal passages, which, in turn, opens clogged nasal passages and enhances drainage of the sinuses. These drugs are used for the temporary relief of nasal congestion caused by the common cold, hay fever, sinusitis, and other respiratory allergies.

Mass spectrometric identification of proteinous allergens

Nine patients with a long history in summer hay fever were tested for symptoms after inhalative and dietary contact with elderberry products. All of them reported rhinoconjunctivitis four of them even exhibited asthmatic symptoms. As patients may be exposed to the allergens hailing from S. nigra via the oral route flowers and fruits have been used in plant remedies and food for centuries it has been of special interest that one patient developed upper-airway obstruction when drinking elderberry juices. Four patients showed strong reactions after SPT, medium response was observed in two cases, and negative results were received for three persons including the patient exhibiting airway obstruction. IgE serum levels measured by RAST also varied significantly. In some cases no serum IgE was detectable in another case up to 4080 kU L was measured.

Isolated angiitis of the central nervous systen is a recently recognized vasculitic disorder primarily involving the

Churg-Strauss syndrome is a rare disorder characterized by hypereosinophilia, systemic vasculitis, and necrotizing granulomatous inflammation that occurs in people with asthma and allergic rhinitis. Pulmonary infiltrates occur in up to 90 of patients, and a cutaneous eruption is seen in 70 . Cardiac manifestations (pericarditis, cardiomyopathy, and myocardial infarction) account for about half of deaths. Peripheral neuropathy is found in 70 of patients its occurrence in susceptible patients is highly suggestive of CSS. Renal disease, seldom seen, is generally mild.

Immediate Hypersensitivity

Wheel And Flare Allergy Skin Test

Immediate hypersensitivity can produce allergic rhinitis (chronic runny or stuffy nose) conjunctivitis (red eyes) allergic asthma atopic dermatitis (urticaria, or hives) and other symptoms. These symptoms result from the immune response to the allergen. In people who are not allergic, the allergen stimulates one type of helper T lymphocyte, the TH1 cells, to secrete interferon-y and inter-leukin-2. In people who are allergic, dendritic cells stimulate the other type of helper T lymphocytes, the TH2 cells, to secrete other lymphokines, including interleukin-4 and interleukin-13. These, in Hay fever, asthma, and most other allergic conditions The symptoms of hay fever (itching, sneezing, tearing, runny nose) are produced largely by histamine and can be treated effectively by antihistamine drugs that block the Hj-histamine receptor. In asthma, the difficulty in breathing is caused by inflammation and smooth muscle constriction in the bronchioles as a result of chemicals released by mast...

Clinical Aspects Immunity

Hypersensitivity is a harmful overreaction of the immune system, commonly known as allergy. In cases of allergy, a person is more sensitive to a particular antigen than the average individual. Common allergens are pollen, animal dander, dust, and foods, but there are many more. A seasonal allergy to inhaled pollens is commonly called hay fever. Responses may include itching, redness or tearing of the eyes (conjunctivitis), skin rash, asthma, runny nose (rhinitis), sneezing, urticaria (hives), and angioedema, a reaction similar to hives but involving deeper layers of tissue.

Advances in Medical Management

It is said that to be a good surgeon you also have to be a good physician. Surgical maneuvers cannot cure the majority of patients with noninfective nasal polyps, any more than they can cure allergic rhinitis. Advances in instrumentation, computer-aided surgery, and optics may refine surgical techniques, but it seems likely that the main advances will come through research into the etiology and pathological mechanisms of allergic and idiopathic rhinitis and nasal polyposis, and the development of new medical therapies.

Localized Anaphylaxis Atopy

In localized anaphylaxis, the reaction is limited to a specific target tissue or organ, often involving epithelial surfaces at the site of allergen entry. The tendency to manifest localized anaphylactic reactions is inherited and is called atopy. Atopic allergies, which afflict at least 20 of the population in developed countries, include a wide range of IgE-mediated disorders, including allergic rhinitis (hay fever), asthma, atopic dermatitis (eczema), and food allergies. ALLERGIC RHINITIS The most common atopic disorder, affecting 10 of the U.S. population, is allergic rhinitis, commonly known as hay fever. This results from the reaction of airborne allergens with sensitized mast cells in the conjuncti-vae and nasal mucosa to induce the release of pharmacologically active mediators from mast cells these mediators then cause localized vasodilation and increased capillary permeability. The symptoms include watery exudation of the con-junctivae, nasal mucosa, and upper respiratory...

Novel Therapeutic Strategies

Mucociliary Transport Rhinitis

It has been suggested that there is a balance in an individual's helper T-cell response between TH1 cells and Th2 cells (Berger, 2000). TH1 cells produce cytokines that produce the pro-inflammatory responses responsible for killing intracellular parasites and for perpetuating autoimmune responses. TH2 cells produce cytokines associated with the promotion of IgE and eosinophilic responses in atopy (Fig. 16.2). It has been suggested that in allergic rhinitis and seasonal asthma, an individual with a genetic predisposition toward a TH2-biased immune system could move away from this bias if exposed to certain environmental stimuli early in life (Openshaw and Walzl, 1999 Openshaw and Hewitt, 2000). Early exposure to microbial agents may be the appropriate stimulus causing the immune system in these individuals to move toward a TH1-depend-ent system (Strachan et al., 2000). Without this biological programming, the bias would persist and the individual would tend toward a TH2-dependent...

Diseases of the respiratory system J00J99

_ Vasomotor and allergic rhinitis Includes spasmodic rhinorrhoea Excludes allergic rhinitis with asthma ( J45.0 ) rhinitis NOS ( J31.0 ) J30.1 Allergic rhinitis due to pollen Hay fever J30.2 Other seasonal allergic rhinitis J30.3 Other allergic rhinitis Perennial allergic rhinitis J30.4 Allergic rhinitis, unspecified

Confirm the Diagnosis

Turbinate Hypertrophy

Patients with genuine chronic bacterial rhinosinusitis who do not respond to medical treatment are often helped by surgery, unless they are immuno-suppressed, when caution is needed (Fig. 8.1). It is important to make sure as far as possible that your patient has a diagnosis that is likely to respond, at least in part, to surgical intervention. Operating on a patient who has only allergic rhinitis is very unlikely to help them (Fig. 8.2). If their CT is normal or shows turbinate hypertrophy without evidence of sinus disease, retake

Type I Hypersensitivities Can Be Controlled Medically

Eliminate them completely, in a significant number of individuals suffering from allergic rhinitis. Such repeated introduction of allergen by subcutaneous injections appears to cause a shift toward IgG production or to induce T-cell-mediated suppression (possibly by a shift to the TH1 subset and IFN-7 production) that turns off the IgE response (Figure 16-12). In this situation, the IgG antibody is referred to as blocking antibody because it competes for the allergen, binds to it, and forms a complex that can be removed by phagocytosis as a result, the allergen is not available to crosslink the fixed IgE on the mast-cell membranes, and allergic symptoms decrease. Knowledge of the mechanism of mast-cell degranulation and the mediators involved in type I reactions opened the way to drug therapy for allergies. Antihistamines have been the most useful drugs for symptoms of allergic rhinitis. These drugs act by binding to the histamine receptors on target cells and blocking the binding of...

Immunoglobulin E Cytokines and Chemokines in Rhinitis

Several workers have reported the local production of IgE in patients with a negative skin-prick test (Huggins and Brostoff, 1975), and in a proportion of people who are now classified as having nonallergic or idiopathic rhinitis (Powe et al., 2001, 2003). Several groups have proposed that the nasal mucosa has the ability to produce allergen-specific IgE locally (Huggins and Brostoff, 1975 Kleinjan et al., 2000 Powe et al., 2001).There may be mechanisms other than allergy that can produce eosinophilia. For example, the common cold has been shown to produce a prolonged influx of IgE receptor-bearing eosinophils in patients with allergic rhinitis (Van Benton et al., 2001). Are the mucosal changes the aftermath of an infection that has upregulated cy-tokines (Kramer et al., 2000), resulted in chemokines such as eotaxin-2 (Jahnsen et al., 1999 Murdoch and Finn, 2000), and altered the genetic expression of mucus (Voynow et al., 1998) or the production of proteoglycans (Lee et al., 2001)...

Role in Allergic Diseases

Ciclon Flora Cuba

Asthma, however53 and IL-10 release from peripheral blood monocytes is increased during the late response to allergen54 and in bronchoalveolar lavage after allergen challenge.53 Nasal allergen challenge in patients with seasonal allergic rhinitis reduces the concentrations of IL-10 in nasal lavage, however, in line with most of the studies in asthma.55 In atopic dermatitis an increase in IL-10 expression in the epidermis has been described.56

Anhydrobiosis and humans

Although the idea of putting humans into suspended animation is likely to remain in the realms of science fiction, at least for some time to come, anhydrobiotic organisms affect human welfare and research on anhydrobiosis has produced, or has the potential to produce, technologies of use to us. The ability of many microorganisms to survive anhydrobiotically means they can be dispersed through the air. This results in the contamination and spoilage of food and in the spread of disease. Allergies (hayfever) result from the inhalation of airborne pollen and algae. The seeds of many weed plants are also dispersed by air. Plant-parasitic nematodes cause crop failure and reduced yields.

Vernal and Atopic Keratoconjunctivitis

GPC is a chronic inflammatory process leading to the production of giant papillae ( 0.3 mm) on the tarsal conjunctiva lining the upper eye lids (fig. 1). The condition occurs in patients who wear soft contact lenses, an ocular prosthesis or have unburied sutures after surgery 37 . The etiology is uncertain and probably multifactorial, but the clinical picture resembles that of VKC 38 . It seems to be a delayed-type hypersensitivity reaction. The symptoms are pseudoptosis, redness, irritation, mucoid discharge, blurring of vision, tearing and photophobia. The eye is dry and the upper eye lid will show the characteristic giant papillae on the tarsal, and sometimes in the forniceal, conjunctiva (fig. 1). Mucous, cell debris and microorganisms are frequently found on the lenses and play a pathogenic role in GPC 39 . The immune privilege of the eye may reduce the incidence of intraocular inflammation. However, the lens produces a continuous antigenic stimulus evoking a localized allergic...

Immunoglobulin E IgE

Componente Secretor Iga

The potent biological activity of IgE allowed it to be identified in serum despite its extremely low average serum concentration (0.3 g ml). IgE antibodies mediate the immediate hypersensitivity reactions that are responsible for the symptoms of hay fever, asthma, hives, and anaphylactic shock. The presence of a serum component responsible for allergic reactions was first demonstrated in 1921 by K. Prausnitz and H. Kustner, who injected serum from an allergic person intra-dermally into a nonallergic individual. When the appropriate antigen was later injected at the same site, a wheal and flare reaction (analogous to hives) developed there. This reaction, called the P-K reaction (named for its originators, Prausnitz and Kustner), was the basis for the first biological assay for IgE activity.

Nasal Obstruction

Patients with allergic rhinitis, whether they have hay fever within season or perennial allergic rhinitis, will be helped by taking antihistamines up to and after surgery, in order to reduce the amount of secretions they produce and the amount of mucosal swelling following surgery.

Immune Function

Mediated process was implicated in the etiology of schizophrenia (Rappaport and Delrahim 2001). Paradoxically, however, studies of specific immunological disorders have generally supported lower prevalence rates among schizophrenic populations. For example, Ehrentheil (1957) and Lipper and Werman (1977) have noted a decreased incidence of asthma, hay fever, and other allergic reactions in schizophrenic patients. Other studies, such as Sabbath and Luce (1952), showed an alternating pattern of coexisting psychosis and allergies.


The leukotrienes are involved in allergic responses and inflammatory processes. An antigen-antibody reaction can result in the release of compounds such as histamine (see page 379) or materials termed slow reacting substance of anaphylaxis (SRSA). These substances are then mediators of hypersensitive reactions such as hay fever and asthma. Structural studies have identified SRSA as a mixture of LTC4, LTD4 and LTE4. These cysteine-containing leukotrienes are powerful bronchoconstrictors and vasoconstrictors, and induce mucus secretion, the typical symptoms of asthma. LTE4 is some 10-100-fold less active than LTD4, so that degradation of the peptide side-chain represents a means of eliminating leukotriene function. LTB4 appears to facilitate migration of leukocytes in inflammation, and is implicated in the pathology of psoriasis, inflammatory bowel disease, and arthritis. The biological effects of leukotrienes are being actively researched to define the cellular processes involved. This...

Simmend Disease

Adelroth E, Rak S, Haahtela T, Aasand G, Rosenhall L, Zetterstrom O, Byrne A, Champain K, Thirlwell J, Della C (2000) Recombinant humanised mAb-E25, an anti-IgE mAb, in birch pollen-induced seasonal allergic rhinitis. Journal of Allergy and Clinical Immunology 106(2) 253-259. Huggins K, Brostoff J (1975) Local production of specific IgE antibodies in allergic rhinitis patients with negative skin tests. Lancet 2 148-150. Jones NS (1999 c) Current best treatment in children with allergic rhinitis. Current Medical Literature - Allergy 7(3) 4956. Kleinjan AJK, Vinke JG, Severijnen LW, Fokkens WJ (2000) Local production and detection of (specific) IgE in nasal B-cell and plasma cells of allergic rhinitis patients. European Respiratory Journal 15 491-497. Kramer MF, Ostertag P, Pfrogner E, Rasp G (2000) Nasal inter-leukin-5, immunoglobulin E eosinophilic cationic protein, and soluble intercellular adhesion molecule-1 in chronic sinusitis, allergic rhinitis, and nasal polyposis. Laryngoscope...


Scan Sinus Abnormality

Ostia, thereby interfering with aeration of the sinuses and creating a closed space that is susceptible to bacterial infection. Sinusitis is, therefore, more likely in the elderly with allergic rhinitis, nasal septal deviation, nasal fractures, nasal polyps or tumors. About 5-10 of cases of bacterial maxillary sinusitis are secondary to dental root infection. Sinusitis is generally subdivided into acute sinusitis (symptoms less than 3 wk), subacute sinusitis (symptoms lasting 3 wk-3 mo) and chronic sinusitis (symptoms lasting longer than 3 mo). Sinusitis may potentially cause serious intracranial suppurative complications such as meningitis, brain abscess, epidural abscess, and subdural empyema. ACE inhibitors, guanethidine, cocaine abuse, etc.) Allergic rhinitis Sinus tumors Sarcoidosis Nasal foreign body Midline granuloma Wegner's granulomatosis

Acute Otitis Media

Otitis media arises from eustachian tube dysfunction that accompanies URIs or allergic rhinitis. Inflammation of the eustachian tube and middle ear results in tube occlusion and fluid accumulation in the middle ear space. Eustachian tube obstruction is more common in younger children because of less cartilage support of the tube, making collapse more likely. The Eustachian tube obstruction not only causes entrapment of existing fluid but also produces a negative pressure in the middle ear that results in additional fluid accumulation that characterizes serous otitis media. Contamination of this fluid with bacteria results in acute suppurative otitis media. Otitis media also may result from noninfectious obstruction of the eustachian tube. Allergic rhinitis, as noted previously, is one such mechanism. Other causes include enlargement of the adenoids and posterior pharyngeal tumors.

Medical Management

Patients with allergic rhinitis are advised to continue their topical nasal steroid therapy after douching and to follow their preoperative treatment strategy (e.g., allergen avoidance, antihistamines). Nasal drops enter the frontal sinus best if they are given with the patient lying flat and with their head cocked back over the edge of the bed. It is often difficult for a patient to gauge how many drops they have instilled in this position and it can be helpful to keep the drops in the fridge, so as to provide more sensation when they are put in. As with all patients with allergic rhinitis, the importance of compliance should be explained. In patients with nasal polyposis, topical nasal steroids are given for 3 months and then reduced if the mucosa looks healthy (Fig. 13.4). In patients with allergic aspergillosis or invasive aspergillosis, itraconazole is preferable to amphotericin as it is associated with fewer side effects. Nevertheless, liver function and morning cortisol levels...

Acute Sinusitis

In children seen in a large health system, sinusitis is frequently found as a co-morbidity with otitis media. Nearly half of all children with sinusitis also had otitis media (40). Children are also more likely to have posterior ethmoidal and sphenoid inflammation while adults have mainly maxillary and anterior ethmoidal sinusitis (41). Some medical conditions may increase the risk for sinusitis. These include cystic fibrosis, asthma, immunosuppression, and allergic rhinitis (42). Cigarette smoking may also increase the risk of bacterial sinusitis during a cold because of reduced mucociliary clearance.


The use of immunotherapy in grass pollen allergic rhinitis has been proven in the short- and long-term (Durham et al., 1999). However, if there is cross-reactivity to a range of inhaled allergens, then im-munotherapy directed at one allergen is less effective. Similarly, the evidence to support allergen avoidance is mixed. The results of house dust mite desensitiza-tion have been equivocal. Fungal immunotherapy following surgery for allergic fungal sinusitis has helped prevent recurrence and it has been postulated that this may help patients with eosinophilic mucin rhi-nosinusitis (Ferguson, 2000). The benefits of allergen avoidance are contentious. When there is a marked single allergen, for example, to house dust mite, then going to great lengths to avoid this allergen has been shown to help. However, it is debatable how well these studies can be extrapolated into day-to-day practice, and whether patients are ready to comply with these measures. It appears that half-measures to...

The Markers of Atopy

In allergic rhinitis there is good epidemiological and basic scientific evidence that there is an inherited genetic component that is responsible (Moffat et al., 1994 Jones et al., 1998b). However, why do 15.5 of asymptomatic people who have a positive skin-prick test not develop any allergic symptoms (Droste et al., 1996) (Fig. 16.3), and not all those with a raised IgE have symptoms of rhinitis (Panzani et al., 1993) (Fig. 16.4) In another study of skin-prick tests, 18 of children changed over a 2-year period (Droste et al., 1996). An understanding of the normal course of these processes may help us to influence our immune status and suppress the excessive response to some foreign antigens that leads to the symptoms of allergic rhinitis.

E123b E123b E 2 B

Disrupting the disulfide bond(s) of the 66 kDa protein leads to the observation of just one protein band at 33 kDa giving hint to the fact that the protein is consisting of two subunits of identical molecular weight linked via one or more disulfide bonds. However, out of these numerous proteins comprised in the flower extract just one predominant protein at about 33 kDa under reducing conditions could be defined as allergenic by testing patients' sera for their IgE-binding profile using immunoblots (Fig. 2B). This very same allergen could be determined within all pollen, berry, and flower extracts whereby the concentration in pollen seems to be highest compared to fruits and blossoms. Identity of the detected proteins at 33 kDa in the plant materials was validated by testing a serum pool from mice immunized with elderberry pollen extract. It has to be mentioned that only a few number of plants (e.g., birch) show a similar profile of containing just a single allergen...